To explore the impact of antidepressant use on delirium and outcomes in patients with intracerebral hemorrhage (ICH).

Neurotransmitter dysregulation is thought to be a principal factor in the pathogenesis of delirium, but the relationship between antidepressants and delirium is unclear.

We performed a single-center cohort study on consecutive patients with non-traumatic ICH admitted over two years. Demographics and data related to clinical stroke care were prospectively collected, while medication data were retrospectively abstracted from patient records. Delirium was diagnosed according to DSM-5 criteria and classified as persistent or resolved at hospital discharge. We used multivariable logistic regression to determine associations between antidepressant use and incident delirium across the entire cohort, and persistent delirium and 3-month functional outcomes in patients who survived their ICH hospitalization.

Among 590 ICH patients in our cohort, 21.2% (n=125) had pre-morbid antidepressant use (SSRIs 63.2%, SNRIs 17.6%, trazodone 16.8%, mirtazapine 12.8%, bupropion 6.4%), while 31.4% (143/456) of ICH survivors were prescribed antidepressants at hospital discharge. Delirium occurred in 59.0% (n=348) of all patients (including 64.8% of patients with pre-morbid antidepressant use vs. 57.4% of those without antidepressant use; p=0.14), and was persistent at hospital discharge in 26.8% (59/220) of all survivors who experienced delirium (35.7% vs. 23.7%, respectively; p=0.08). In multivariable models adjusted for demographics and ICH severity, pre-morbid antidepressant use was associated with higher rates of incident delirium (OR 1.63, 95% CI 1.00-2.67; p=0.049) and similar albeit non-significantly higher rates of persistent delirium (OR 1.62, 95% CI 0.80-3.30). Among ICH survivors who developed delirium, there was no significant association between antidepressant prescription at discharge and unfavorable 3-month outcomes (OR 0.96, 95% CI 0.49-1.85).

Pre-morbid antidepressant use may be associated with delirium in patients with stroke, potentially supporting the role of neurotransmitter dysfunction in delirium pathogenesis. Further studies are needed to confirm these findings.